Sunday, July 4, 2004

Creatine: Do risks outweigh rewards?

By Tom Groeschen
Enquirer staff writer

Brandon Rozier is like many high school football players seeking gains in size and strength.

The Princeton High School senior linebacker knows the perception that getting bigger produces better results for an aspiring career.

Although he has vowed never to use steroids, the 5-foot-11, 195-pound Rozier once tried creatine, but he soon decided against it.

creatine Despite recent news stories and a University of Michigan survey that said 3.5 percent of high school senior respondents used steroids at least once, up from 2.1 percent in 1991, many Greater Cincinnati and Northern Kentucky prep athletes say they would never use steroids. Ditto for other bodybuilding substances banned or condemned by state high school athletic associations and many NCAA and professional sports.

But creatine monohydrate, a dietary supplement said to "help fuel skeletal muscles," quickly is becoming a young athlete's way of avoiding the stigma of steroids - whose side effects can include heart disease, liver damage, rage and shrunken testicles -while getting similar results.

"I used creatine for about a month last summer, but I stopped because I learned too many things about the side effects," Rozier said. "There's a lot of pressure to get bigger and go play in college, but it wasn't worth it."

Creatine, still relatively new having appeared on vitamin store shelves about a dozen years ago, has been known to have side effects including nausea, muscle cramps and dehydration, according to anecdotal evidence and sports medicine officials who speculate that it could increase the likelihood of such effects.

"The tests are not definitive yet, but they've shown the possibility (of side effects)," said Dr. Ted Lambrinides, a Green Township resident considered by many to be the Greater Cincinnati authority on dietary supplements.

Lambrinides, who has a Ph.D. in exercise physiology, is on the NCAA speakers' bureau for dietary supplements and gives about 20 lectures nationwide annually, including a recent presentation to the NFL's Jacksonville Jaguars.

Lambrinides, commenting on the side effects of creatine, said a University of Kansas study also showed the potential of anterior compartment pressure (tightness in the calf and/or shin splints) from using creatine.

Creatine generally is used in the United States as a sports supplement. Most studies have shown it to improve performance during high-intensity exercise of short duration, such as weightlifting and sprinting.

Creatine is a naturally occurring amino acid taken in concentrated form. The flavorless creatine powder can be mixed with sports drinks with the goal to attain muscle mass and increase strength.

It is produced in the body and also is available from meat in the diet, including poultry and fish.

Creatine use is most found in the so-called power sports (football, wrestling, hockey and bodybuilding), although increasingly in other sports, such as baseball.

Several reports say creatine has been found at all levels of performance - from professional to amateur, college, high school and middle school.

Another study by the Blue Cross and Blue Shield Association found an estimated 1 million young people ages 12-17 have taken performance-enhancing sports supplements.

Easy to find

Legal, over-the-counter supplements - reported by Sports Illustrated in 2003 to be a $17.7 billion business - include everything from protein shakes and bars and creatine to excessive amounts of caffeine, and even products that contain harder-edged substances such as the now-banned androstenedione and ephedra.

What is in the magic pill, drink or sports supplement you are using? The following is a guide to some of the more common ingredients in sports supplements, and their potential dangers:


• An extract of the Chinese plant ma huang that stimulates cardiovascular and central nervous systems. Now illegal to use or sell in the United States.

• Once found in weight-loss, energy-boosting and bodybuilding products such as Stacker 2 and Metabolife 356, both now advertised as "ephedra free."

• Potential risks: Can cause elevated blood pressure. When taken in excessive doses or by people with certain medical conditions, can result in cardiac arrhythmia, heart attacks, seizures or strokes.

• Banned by: U.S. Food and Drug Administration (April 2004).


• Natural compound created from three amino acids produced by the liver and kidneys and used by muscles and organs as an energy source.

• Found in supplements designed to increase muscle mass and build strength and endurance, such as Pro Performance Creatine Monohydrate; also found in red meat and some fish.

• Potential risks include dehydration, diarrhea, stomach cramps and muscle and ligament tears.

• Banned by: Not banned by any governing bodies.


• Steroid precursor that stimulates the body's production of testosterone.

• Found in supplements such as Andro 100 Poppers, the body converts andro into testosterone, which is believed to increase lean muscle mass.

• Potential risks include the possibility of producing adverse effects linked to anabolic steroids, breast enlargement and testicular atrophy in men; breast shrinkage and deepened voice in women; growth retardation in teens.

• Banned by: NBA, NFL, NCAA, World Anti-Doping Agency (which oversees Olympic drug testing). In March 2004, FDA warned 23 companies to stop marketing andro.


• An extract taken from orange peel and used as a substitute for ephedra. Sometimes called bitter orange.

• Found in weight-loss, energy boosting and bodybuilding products. Marketed as "ephedra free" products. Used in Stacker 2 Ephedra Free, Xenadrine EFX Ephedra Free and Metabolife Ephedra Free.

• Potential risks include pharmacological and toxic properties similar to ephedra; could cause an athlete to test positive for ephedra, depending on test methodology.

• Banned by: NCAA.


• Chemically produced enhancer of hGH (a substance made by the pituitary gland for growth and cell repair) used by those seeking to build strength.

• Found in products such as Ultimate HGH, contains substances such as amino acids said to help the body release hGH.

• Potential risks include elevated hGH levels, which can damage heart and liver and promote growth of jaw, forehead, hands and feet. Also might cause diabetes.

• Banned by: NFL, NCAA and WADA.


• Stimulant and mild diuretic causes a feeling of heightened alertness.

• Found in some coffee, tea, chocolate, colas, energy drinks such as Red Bull, and headache tablets.

• Potential risks include mild addictions. When used in large quantities can cause cardiac arrhythmia.

• Banned by: NCAA, WADA (in amounts roughly equivalent to consuming eight cups of coffee in a two-hour time frame).


SOURCES: Sports Illustrated, Princeton High School strength coach Mike Shibinski, Moeller High School strength coach Todd Naumann, exercise physiologist Dr. Ted Lambrinides, Internet research.

More info: See our chart

Ephedra, an herbal stimulant also once prominent in the dietary-supplement industry, recently was banned by the Food and Drug Administration after being linked to 155 deaths, including Baltimore Orioles pitcher Steve Bechler's in 2003.

"There are now ephedrine substitutes that they advertise as ephedra-free, but they are not risk-free either," Lambrinides said. "The ingredient they add in there is very similar in terms of its chemical substance."

Creatine can be bought online, via muscle magazines or at your local GNC or other vitamin store, costing between $20 and $30 for a 1-pound tub of powder. Sales of creatine have grown by 730 percent since 1995, according to

Patrick Fitzgerald, public relations director for GNC, said the franchise cannot discuss sales numbers because of a registration it is undergoing as part of an initial public offering. As a private company, GNC does not break out revenue by specific products, Fitzgerald said, but he did say GNC's creatine sales continue to be strong.

Lambrinides said that because creatine is legal and easy to obtain, it has become a popular supplement. But what you see might not be what you get.

"One problem is that about 25 percent of all these supplements are contaminated, laced with other substances that aren't on the label," Lambrinides said.

"A lot of kids may be taking them inappropriately, whether they're legal or not."

Hard work, or hardly working?

Even locally, coaches are resigned to the fact that some athletes will take the legal supplements.

"We've had some kids use creatine," Dixie Heights athletic director and head football coach Tom Spritzky said. "I've never had kids shoot up with (steroids). But if they want to take supplements, I suggest they talk to a doctor first. I encourage them not to do supplements, but if parents approve it, that's up to them."

With elixirs promising everything from bigger muscles to instant energy to "washboard abs," athletes seeking scholarships and perhaps professional sports careers might be tempted more than ever to use supplements, which can range from pills to powders, even gums.

"I've never used any of that myself, but I know it's given a bad name to the players who just rely on hard work," said J.T. Imming, a recent St. Xavier graduate who will play baseball next season at the University of Dayton. "I've seen guys use supplements like protein in football, but I don't see how it gives you any better odds of playing in college or the pros someday."

Indeed, the odds are astronomical. Less than 1 percent of high school athletes will make it to the professional sports level, according to an NCAA News report in 2000.

In football, 5.8 percent of high school athletes will play in college at the NCAA level. In boys' basketball only 2.9 percent reach the NCAA, and in girls' basketball it's 3.1 percent. The numbers are similar for other sports.

Bruce Kozerski, a former Cincinnati Bengals offensive lineman (1984-95) and now head football coach at Holy Cross High School, discourages the use of supplements by his players.

"The Bengals didn't like that stuff either, because they're a wholesome, family-type club," Kozerski said. "And now as a parent, you think about that kind of thing all the time."

Kozerski's son, Matt, is a 6-foot-1, 160-pound tight end/linebacker entering his junior year at Holy Cross.

"He hasn't brought up anything about supplements," Bruce Kozerski said. "But I have had players ask me what they could use, and I say, 'You know what? Just eat right and work hard.'

"I'm not na‘ve enough to think it doesn't go on. Some kids are not meant to be the biggest people, genetically. Those are the guys you want to watch."

Rozier said a few of his fellow Princeton football players have tried creatine. Most athletes interviewed by the Enquirer said they knew someone or had heard stories about athletes using supplements.

"I didn't feel anything when I used it, but I didn't use it long," Rozier said. "I just think you're better off eating right and doing the proper weight training. You hear too many things about what can go wrong."

Moeller football players Patrick Farrell and Brian Hoffer said they know of several teammates who have used creatine. Even more use protein shakes, a fairly common practice among athletes in training.

"I've used the protein drinks, and there are a lot of kids using creatine," said Farrell, a 6-2, 265-pound lineman. "But I think it's kind of pointless to take creatine. You've got to stay on it to get anything out of it."

Hoffer, a wiry 6-foot, 160-pound wide receiver, said: "I've just heard of guys doing creatine, but I haven't seen it. There's no pressure to try it, but I guess some guys just want to get some kind of edge."

Dave Guidugli of Fort Thomas, whose son Gino is the starting quarterback at the University of Cincinnati, is also a well-known athletic trainer (Guidugli Speed, Strength and Stamina) who strongly advises against steroids and supplements.

"I don't believe in that stuff. I've had coaches look the other way and tell me to get guys bigger and stronger, and they don't want to know how," Guidugli said. "It's getting to be an epidemic thing in high schools and colleges, because everybody is looking for that edge."

Moeller athletic trainer Craig Lindsey said he knows of a few prep athletes who have taken creatine.

"Some kids are so competitive they don't care what they put in their bodies, but I ask them, 'Is this really what you want to do?' " Lindsey said.

Pressure to succeed

Local doctors, trainers and strength coaches all speak against dietary supplements.

Dr. Timothy Kremchek, the Cincinnati Reds' medical director and team physician for many area high schools, points to the pressure to succeed as the culprit.

Kremchek blames it partially on a growing win-win sports mentality, which includes "select" summer teams in numerous sports, including baseball, basketball, soccer and volleyball.

"There's no question that the pressure to win is worse than ever," Kremchek said. "Kids need to keep up, and that sometimes leads them to try things they shouldn't."

Mike Shoemaker, a former University of Cincinnati football quarterback (1970-74), has seen it from both sides. Shoemaker's son, Kurt, just completed his career as a standout football quarterback and basketball player at Anderson High School.

"Kurt and I have talked about staying in shape, and he asked me once whether he should take creatine," Mike Shoemaker said. "I told him that as long as he can keep competing at the level he does, he didn't need it. I just don't think it's worth it."

Kurt, 6-3 and 200 pounds, will play football for the University of Akron next season. He has good size for a quarterback and was one of Greater Cincinnati's best prep players.

Mike Shoemaker, a star quarterback at Newport High School before attending UC, said the entire approach to conditioning has changed since he played 30 years ago.

"We didn't even have a strength coach at UC then," he said. "Now, the strength programs are more sophisticated and there's pressure to stay in shape, and to play one sport year-round. The temptation is very great for kids to take some performance-enhancing drug, and as a parent you don't want to see that happen."

Today, some high schools have their own strength coaches and state-of-the-art weight rooms.

Princeton strength coach Mike Shibinski puts out his own seven-page handout to Vikings athletes, warning against popular muscle magazines and other sources that offer that "ripped physique" appearance via supplements. Shibinski also lists the right ways to improve one's health, including proper eating and sleeping habits.

"Mother Nature regulates how fast you mature physically," Shibinski said. "That process, no matter how hard you try, cannot be speeded up."

Nutritional supplements aren't needed, Shibinski said.

"The key is to make sure you are eating enough calories to generate maximum gains in strength and size, and recover completely from practice, exercise and games," Shibinski said.




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